DE60103474T2 - Liquefaction handpiece - Google Patents

Description

background the invention

These The invention relates generally to the field of gray operation Stars and in particular a handpiece to carry out the Liquefracture technique for the removal of cataracts.

The human eye works in the simplest way so that that eyesight It is based on the fact that light through a clear outer area, the cornea is called, transmitted and the image is focused on the retina using the lens becomes. The quality of the focused image hangs of many factors including the Size and the Shape of the eye and the transparency of the cornea and the lens.

If the age or disease are responsible for that lens becomes less transparent, eyesight deteriorates due to the reduced amount of light that can be transmitted to the retina. These insufficiency The lens of the eye is known medically as a cataract. A recognized treatment of this condition is surgical removal the lens and replacing the lens function with an artificial one intraocular lens (IOL).

In the United States is the majority of the cataract lenses removed with a surgical technique, phacoemulsification is called. This procedure becomes a thin phacoemulsification cutting tip introduced into the diseased lens and excited to vibrate with ultrasound. The vibrating cutting tip liquefied or emulsifies the lens so that it can be sucked out of the eye. The diseased lens becomes replaced after its removal by an artificial lens.

A typical ultrasonic surgical device used for eye treatments is suitable, consists of an ultrasonic handpiece, a attached cutting tip, an irrigation sleeve and an electronic Control console. The handpiece arrangement is with an electric cable and flexible hoses at the Control console connected. With the console is over the electrical cables transmitted through the handpiece to the cutting tip attached thereto Power level varies. Further, via the flexible hoses irrigation fluid fed to the eye and sucked fluid sucked from the eye through the handpiece assembly.

Of the authoritative Part of the handpiece is a centrally located hollow swinging rod or horn, attached directly to a group of piezoelectric crystals is. The crystals controlled by the console provide the required Ultrasonic vibration that needed will be to both the horn and the attached cutting tip while to drive the phacoemulsification. The crystal / horn arrangement is in the hollow body or the shell of the handpiece suspended with flexible brackets. The body of the handpiece ends in a section with a reduced diameter or Nasal cone at the distal end of the body. The nose cone is outside with threaded to receive the watering sleeve. In similar Way, the bore in the horn is at one with its distal end Threaded to the outer thread to absorb the cutting tip. The irrigation sleeve also includes one with a Internally threaded bore, which screwed onto the external thread of the nose cone becomes. The cutting tip is adjusted so that the tip only by one predetermined amount protrudes from the open end of the irrigation sleeve. Ultrasonic handpieces and cutting tips are described in further detail in the US patents 3,589,363; 4,223,676; 4,246,902; 4,493,694; 4,515,583; 4,589,415; 4,609,368; 4,869,715; 4,922,902; 4,989,583; 5,154,694 and 5,359,996 described.

At the Use the ends of the cutting tip and the irrigation sleeve in a narrow Incision with a predetermined width in the retina, the dermis or introduced elsewhere. The cutting tip is ultrasonically along its longitudinal axis in the watering sleeve the crystal-driven ultrasonic horn is excited to vibrate, causing the selected Tissue is emulsified locally. The hollow hole of the cutting tip is in communication with the hole in the horn, which in turn is in communication with the suction line from the handpiece to Console is located. A vacuum or vacuum source in the console the emulsified tissue pulls or sucks from the eye through the open End of the cutting tip, the cutting tip and horn bore and the suction line and into a collecting device. The suction the emulsified tissue is replaced by a salt rinse or irrigation materials support at the place of engagement by the small circular gap between the inner surface the irrigation sleeve and the cutting tip is injected.

Recently, a new cataract removal technique has been developed which involves the injection of hot water or a hot saline solution (approximately 45 ° C to 105 ° C) to liquefy or gel the hard lens nucleus, thereby making it possible to to suck the liquefied lens out of the eye. The suction is simultaneous with the injection of the heated solution and the injection a relatively cool solution, whereby the heated solution is rapidly cooled and removed. This technique is described in more detail in U.S. Patent 5,616,120 (Andrew, et al.). However, in the device disclosed in the publication, the solution is heated separately from the surgical handpiece. Controlling the temperature of the heated solution can be difficult because the fluid hoses that provide the handpiece are typically up to two meters long and the heated solution can cool considerably as it travels the length of the hose.

The U.S. Patent 5,885,243 (Capetan, et al.) Discloses a handpiece having a handle separate pumping mechanism and a resistance heating element. A Such a structure complicates the handpiece in an unnecessary manner Wise. A liquefracture hand piece of the type described here is also disclosed in our European Patent Applications EP-A-0,962,203, EP-A-962,204 and EP-A-0,962,205.

Outline of the invention

The present invention over the prior art one Improvement by using a surgical handpiece according to the following claims two coaxially mounted pipes or channels is provided, the mounted on a body are. The first pipe is used for suction and has a smaller one Diameter than the second tube, being between the first and second Tube a ring-shaped Passage is made. The annular gap is in a communication connection with a pumping chamber formed between two electrodes. The functioning The pumping chamber is a small volume of surgical Boil fluids. When the fluid boils, it expands rapidly, causing the fluid downstream is driven to the pumping chamber from the annular gap. The distal end of the annular gap is by frictionally joining the distal Ends of the first and second tube sealed. One or more allow in either the first or second tube formed grooves a drive forward of fluid through the annular gap, so that this exits. For example, can by folding over the second tube near the distal end of the second Pipe a barrier be provided on which the exiting Fluid occurs.

Accordingly, it is An object of the present invention, a surgical handpiece with at least to provide two coaxial tubes.

A Another object of the present invention is to provide a handpiece with a To provide pumping chamber.

A Another object of the present invention is to provide a surgical handpiece with a device for delivering the surgical fluid through the handpiece to provide in pulses.

Yet Another object of the present invention is to provide a handpiece with a To provide pumping chamber, which is formed by two electrodes.

Yet Another object of the present invention is a handpiece with two electrodes, the electrodes being insulated.

Yet Another object of the present invention is a handpiece to provide the fluid pulses in a controlled and directed manner Way supplies.

These and other features and advantages of the present invention from the detailed description and the following claims.

Summary the drawings

1 Figure 11 is a front and top left perspective view of a first embodiment of the handpiece of the present invention.

2 Figure 11 is a top right perspective view of a first embodiment of the handpiece of the present invention.

3 Figure 3 is a cross-sectional view of a first embodiment of the handpiece of the present invention taken along a plane passing through the irrigation channel.

4 Figure 11 is a cross-sectional view of a first embodiment of the handpiece of the present invention taken along a plane passing through the suction passage.

5 Figure 3 is an enlarged partial cross-sectional view of a first embodiment of the handpiece of the present invention according to the circle 5 in 4 ,

6 Figure 3 is an enlarged partial cross-sectional view of a first embodiment of the handpiece of the present invention according to the circle 6 in 3 ,

7 Figure 3 is an enlarged cross-sectional view of a first embodiment of the handpiece of the present invention according to the circle 7 in the 3 and 4 ,

8th is a partial cross-sectional view of a second embodiment of the handpiece of the present invention.

9 Fig. 10 is an enlarged partial cross-sectional view of the second embodiment of the handpiece of the present invention according to the circle 9 in 8th ,

10 FIG. 12 is an enlarged partial cross-sectional view of the pumping chamber used in the second embodiment of the handpiece of the present invention according to the circle. FIG 10 in 9 ,

11 Fig. 10 is a partial cross-sectional view of a third embodiment of the handpiece of the present invention.

12 Fig. 15 is an enlarged partial cross-sectional view of the distal end of the third embodiment of the handpiece of the present invention according to the circle 12 in 11 ,

13 FIG. 15 is an enlarged partial cross-sectional view of the pumping chamber used in the third embodiment of the handpiece of the present invention incorporated in FIG 11 and 12 is shown.

14 Figure 11 is a block diagram of a control system that may be used with the handpiece of the present invention.

15 Figure 11 is a longitudinal cross-section of a distal tip that may be used with the handpiece of the present invention.

16 Figure 11 is a perspective view of an alternative distal tip that may be used with the handpiece of the present invention, with the outer tube shown in phantom.

17 FIG. 12 is a transverse cross-section of the distal tip that may be used with the handpiece of the present invention taken along lines 24-24 in FIG 15 ,

18 Figure 12 is a longitudinal cross-section of another alternative distal tip that may be used with the handpiece of the present invention.

19 is a perspective view of the top of 18 in which the outer tube is shown with dashed lines.

20 is a transverse cross section of the top of 18 according to the line 27 - 27 in 18 ,

detailed Description of the invention

The hand piece 10 The present invention generally includes a handpiece body 12 and a functional tip 16 , The body 12 generally comprises an outer irrigation pipe 18 and a suction fitting 20 , The body 12 is similar in structure to the phacoemulsification handpieces known in the art and may be made of plastic, titanium or stainless steel. How best in 6 can be seen, includes the functional tip 16 a lacy / cap sleeve 26 , a needle 28 and a pipe 30 ,

The sleeve 26 may be any suitable commercially available phacoemulsification tip / cap sleeve. The sleeve 26 may also be integrated into tubes other than a multi-lumen tube. The needle 28 may be any type of commercially available hollow phacoemulsification cutting tip, such as the TURBOSONICS tip available from Alcon Laboratories, Inc., Fort Worth, Texas. The pipe 30 can be any pipe of a suitable size that fits in the needle 28 fits, such as a hypodermic needle of strength 29 ,

How best in 5 it can be seen, is the pipe 30 free at the distal end and at the proximal end with the pumping chamber 42 connected. The pipe 30 and the pumping chamber 42 For example, any suitable agent having a relatively high melting point, such as a silicone gasket, a glass frit, or a silver solder, may be fluid-tightly sealed. The connector 44 Hold the pipe 30 in the hole 48 of the Ansaughorn 46 , The hole 48 is in communication with the fitting 20 that in the horn 46 is stored and with an O-ring seal 50 is sealed to an intake passage through the horn 46 and the connector 20 to build. The Horn 46 gets in the body 12 through an O-ring seal 56 and forms an irrigation pipe 52 that is in communication with the irrigation tube 18 at the connection 54 located.

How best in 7 can be seen, contains the pumping chamber 42 in a first embodiment of the present invention, a relatively large pump reservoir 43 , which at both ends by electrodes 45 and 47 is sealed. Electric current becomes the electrodes 45 and 47 fed by insulated wires, not shown. In use, surgical fluid (eg, a salt rinse solution) passes through the tube 34 and the check valve 53 in the reservoir 43 wherein it is the check valve 53 is a well-known in the art valve. Electric current (preferably radio frequency alternating current or RFAC) is due to and due to the conductive nature of the surgical Fluids over the electrodes 45 and 47 created. When the current flows through the surgical fluid, it is boiled. Once the surgical fluid boils, it expands rapidly through the tube 30 from the pumping chamber 42 off (the check valve 53 prevents the expanding fluid from entering the tube 34 entry). The expanding gas bubble pushes the surgical fluid in the tube 30 downstream from the pumping chamber 42 forward. Subsequent current pulses form successive gas bubbles that pass the surgical fluid through the tube 30 move. The size and pressure of the pump chamber 42 The fluid pulses obtained may be varied by varying the length, times and / or power of the electrodes 45 and 47 sent electrical pulses and by varying the dimensions of the reservoir 43 be varied. Additionally, the surgical fluid may enter before entering the pumping chamber 42 to be preheated. The preheating of the surgical fluid leads to a reduction in the pumping chamber 42 required power and / or to increase the speed at which pressure pulses can be generated.

How best in the 8th - 10 can be seen, includes the handpiece 110 in a second embodiment of the present invention generally a body 112 with a power supply cable 113 , Irrigation / suction lines 115 , and a pumping chamber supply line 117 , The distal end 111 of the handpiece 110 contains a pumping chamber 142 with a reservoir 143 that between the electrodes 145 and 147 is trained. The electrodes 145 and 147 are preferably made of aluminum, titanium, carbon or similar conductive materials and are against each other and against the body 112 through an insulating layer 159 such as an anodized layer 159 isolated on the electrodes 145 and 147 is trained. The anodized layer 159 has a lower conductivity than untreated aluminum and thus acts as an electrical insulator. The electrodes 145 and 147 and the electrical connections 161 and 163 are not anodized and therefore electrically conductive. The layer 159 can be formed by any suitable insulation or anodization technique known in the art, and the electrodes 145 and 147 and the electrical connections 161 and 163 can be masked during anodization or machined after anodization to expose bare aluminum. Through the connections 161 and 163 and wires 149 respectively. 151 become the electrodes 145 and 147 powered. Through the Zufühleitung 117 and the check valve 153 Fluid becomes a reservoir 143 fed. An outer tube 165 that is the intake manifold or inner tube 167 Coaxially surrounds extending distally of the pumping chamber 142 , The pipes 165 and 167 can have the same construction as the pipe 30 , The pipe 167 has a slightly smaller diameter than the tube 165 , whereby an annular passage or annular gap 169 between the tube 165 and the tube 167 is formed. The annular gap 169 is in fluid communication with the reservoir 143 ,

In use, surgical fluid enters the reservoir 143 through the supply line 117 and the check valve 153 one. Electric current is due to the conductive nature of the surgical fluid on and across the electrodes 145 and 147 created. The flow of current through the surgical fluid causes the surgical fluid to boil. As the surgical fluid boils, it quickly expands out of the pumping chamber 142 through the annular gap 169 out. The expanding gas bubble pushes the surgical fluid in the annular gap 169 downstream of the pumping chamber 142 forward. Subsequent pulses of electrical current form sequential gas bubbles that pass the surgical fluid through the annular gap 169 move forward or drive forward.

For those skilled in the art can be seen that the numbering in the 8th - 10 for numbering in 1 - 7 except for the addition of "100" in 8th - 10 is identical.

How best in the 11 - 13 can be seen, includes the handpiece 210 in a third embodiment of the present invention generally a body 212 with a power supply cable 213 , Irrigation / suction lines 215 and a pumping chamber supply line 217 , The distal end 211 of the handpiece 210 contains a pumping chamber 242 with a reservoir 243 that between electrodes 245 and 247 is trained. The electrodes 245 and 247 are preferably made of aluminum and against each other and against the body 212 through an anodized layer 259 isolated on the electrodes 245 and 247 is trained. The anodized layer 259 is less conductive than untreated aluminum and therefore acts as an electrical insulator. The electrodes 245 and 247 and the electrical connections 261 and 263 are not anodized and are therefore electrically conductive. The layer 259 can be made by any suitable anodization technique known in the art and the electrodes 245 and 247 and electrical connections 261 and 263 may be masked during anodization or machined after anodizing to expose bare aluminum. Electric current becomes the electrodes 245 and 247 over the connections 261 and 263 and the wires 249 respectively. 251 fed. Fluid becomes a reservoir 243 through the supply line 217 and the check valve 253 fed. From the pumping chamber 242 extends distally the outer tube 265 that the intake pipe 267 Coaxially surrounds. The pipes 265 and 267 can have the same construction as the pipe 30 exhibit. The pipe 267 indicates egg NEN slightly smaller diameter than the pipe 265 on, creating an annular passage or annular gap 269 between the tube 265 and the tube 267 is formed. The annular gap 269 is in fluid communication with the reservoir 243 ,

In use, surgical fluid enters the reservoir 243 over the supply line 217 and the check valve 253 one. Electric current is due to the conductive nature of the surgical fluid on and across the electrodes 245 and 247 created. The flow of current through the surgical fluid causes the surgical fluid to boil. Current flow propagates from the portion of the smaller electrode gap to the larger electrode gap portion, ie, from the lowest electrical resistance region to the higher electrical resistance region. The boiling wavefront also spreads from the narrower to the wider end of the electrode 247 out. As the surgical fluid boils, it quickly expands out of the pumping chamber 242 through the annular gap 269 out. The expanding gas bubble pushes the surgical fluid in the annular gap 269 downstream of the pumping chamber 242 forward. Subsequent pulses of electrical current form sequential gas bubbles that pass the surgical fluid through the annular gap 269 move or drive forward.

For those skilled in the art can be seen that the numbering in the 11 - 13 for numbering in the 1 - 7 except for the addition of "200" in 11 - 13 is identical.

While different Embodiments of handpiece can be disclosed in the present invention, however, each hand piece, with a suitable pressure impulse force, temperature, rise time and Frequency can be generated, also used. For example can any handpiece, with a pressure impulse force between 0.02 g and 20.0 g with a Rise time between 1 g / s and 20,000 g / s and a frequency between 1 Hz and 200 Hz can be used, with a Frequency between 10 Hz and 100 Hz is most preferred. The Pressure impulse force and frequency varies with the hardness of the material being removed becomes. For example, the inventors have found that a low Frequency together with a higher one Impulse force most effective in compressing and removing the relative hard core material is while a higher one Frequency and a lower momentum when removing the softer epinuclear and cortical material are effective. Infusion pressure, the suction flow rate and the limit of negative pressure are similar to common phacoemulsification techniques.

As in 15 - 17 can be seen, points the top 800 an inner tube 867 and an outer tube 865 on. The inner tube 867 is sized so that it is at the distal end 868 in frictional engagement with the outer tube 865 however, being proximal to the distal end 868 the outer diameter of the inner tube 867 is slightly less than the inner diameter of the outer tube 865 so that an annular gap 869 is formed. The annular gap 869 is in communication with the pumping chamber 42 . 142 or 242 , To allow fluid to escape through the annular gap 869 can be driven, is the inner tube 867 at the otherwise frictionally engaged distal end 868 with a groove or notch 871 Mistake. The outer tube 865 can also be with a barrier 873 be provided on the out of the notch 871 emerging fluid impinges. The barrier 873 can be made by any suitable method, such as by folding over the outer tube 865 , Alternatively, the outer tube 865 the groove (not shown), which allows the escape of the fluid include.

As in 18 - 20 can be seen, includes the top 900 an inner tube 967 and an outer tube 965 , The inner tube 967 is sized to match the outer tube 965 at the distal end 968 is in frictional engagement, but proximal to the distal end 968 the outer diameter of the inner tube 967 is slightly less than the inner diameter of the outer tube 965 so that an annular gap 969 is formed. The annular gap 969 stands with the pumping chamber 42 . 142 or 242 in connection. To allow the fluid to escape through the annular gap 969 can be driven forward, the inner tube 967 with a plurality of grooves or notches 971 on the otherwise frictionally engaged distal end 968 be provided. The outer tube 965 can also be with a barrier 973 Be prepared for that from the notches 971 Exiting fluid impinges. A barrier 973 can by any suitable method, such as by folding over the outer tube 965 to be obtained.

As in 14 can be seen, includes an embodiment of the control system 300 for use with the surgical handpiece 310 a control module 347 , a power amplification RF amplifier 312 and a function generator 314 , The RF amplifier 312 is powered by a DC power supply 316 powered, which is preferably an isolated DC power supply, which is operated at several hundred volts, typically at +200 volts. The control module 347 For example, any suitable microprocessor, microcontroller, computer, or digital logic controller can be any input from the input operator 318 receives. The function generator 314 provides the electrical waveform to the amplifier 312 and is typically included about 450 kHz or above operated to minimize corrosion.

In use, the control module receives 347 Input signals from the surgical console 320 , The console 320 may be any commercially available surgical control console, such as the LEGACY® SERIES TWENTY THOUSAND® surgical system, available from Alcon Laboratories, Inc., Fort Worth, Texas. The console 320 is with the handpiece 310 over the irrigation line 322 and the suction line 324 connected and the flow lines 322 and 324 be by the user via the footswitch 326 controlled. Information about the irrigation and suction flow rate in the handpiece 310 be from the console 320 over the interface 328 to the control module 347 supplied with the control terminal of the ultrasonic handpiece to the console 320 or may be connected to any other output terminal. Information from the footswitch 326 passing through the console 320 and an input by an operator from the input device 318 are supplied by the control module 347 ver applies to two control signals 330 and 332 to generate. The signal 332 is used to the pinch valve 334 which controls the surgical fluid from the fluid source 336 to the handpiece 310 flows. The fluid from the fluid source 336 is heated in the manner described here. The signal 330 is used to create the function generator 314 to control. Based on the signal 330 the function generator provides 314 a waveform with the operator-selected frequency and amplitude determined by the position of the footswitch 326 be determined, to RF amplifier 312 where it is amplified to the amplified waveform to the hand piece 310 to generate heated, pressurized pulses of the surgical fluid.

It Any method can be used to measure the amount of heat that is introduced into the eye to limit. For example, the duty cycle of the pulse train the heated solution dependent on be varied from the pulse frequency so that the total amount of heated Solution, which introduced into the eye is not varied with the pulse rate. Alternatively, the Absaugflußrate depending on be varied by the pulse rate so that the Absaugflußrate proportional is increased with an increase in the pulse rate.

The Description is for the purpose of illustration and explanation specified. For Professionals recognize that changes and modifications are made to the invention described above can be without departing from its scope. For example, it will be apparent to those skilled in the art, that the present invention with ultrasonic and / or rotating cutting tips can be combined to increase their performance.

Claims (3)

A liquefaction handpiece comprising: a body ( 12 . 112 . 212 ); a pumping chamber ( 42 . 142 . 242 ) mounted in the body, the pumping chamber being formed by a pair of electrodes allowing electrical current to flow between the electrodes when the surgical fluid is contained in the pumping chamber for boiling a surgical fluid; a peak ( 800 . 900 ) through an inner tube ( 867 . 967 ) formed coaxially in an outer tube ( 865 . 965 ) is mounted around an annular gap ( 869 . 969 ) between the inner tube and the outer tube, the annular gap ( 869 . 969 ) is in fluid communication with the pumping chamber, the inner and outer tubes at a distal end ( 868 . 968 ), and at least one aperture is formed in the distal end of either the outer or inner tube, the at least one aperture being adapted to permit fluid to be propelled along the annular gap to exit the tip; at least one opening through at least one groove or notch ( 871 . 971 ) defined in the distal end of either the outer ( 865 ) or the inner tube ( 867 ) is formed. Liquefaction handpiece after Claim 1, wherein the opening is arranged so that fluid emerging from the top in a directional manner. A liquefaction handpiece according to claim 2, wherein the outer tube comprises a stop ( 873 . 973 ), which is distal to the opening and adapted to cause fluid exiting the opening (s) to impinge thereon.